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Abstrak :
LATAR BELAKANG: Salah satu penyebab kematian bagi penderita kanker pada wanita adalah kanker serviks. Secara histopatologik kanker leher rahim yang banyak ditemukan adalah jenis karsinoma sel skuamosa. Pada penelitian diteliti beberapa faktor risiko yang berkaitan dengan karsinoma sel skuamosa. METODE: Desain studi ialah kasus-kontrol dengan subyek penderita kanker leher rahim jenis karsinoma sel skuamosa berdasarkan pemeriksaan histopatologik yang datang ke RSUPNCM Jakarta dan belum mendapatkan pengobatan. HASIL: Dari 302 wanita penderita kanker leher rahim jenis karsinoma sel skuamosa yang diteliti terdapat 34,4% pada golongan umur 52 tahun sampai 62 tahun yang memiliki risiko tinggi, dengan rasio odd suaian (OR) 24,05 dan 95% interval kepercayaan 6,34 ; 91,24. Umumnya wanita berpendidikan tingkat SD dan wanita tidak sekolah memiliki risiko tinggi dibandingkan dengan wanita yang berpendidikan SMP ke atas, dengan rasio odd suaian berturut-turut 17,97 dan 12,91 dan 95% interval kepercayaan berturut-turut 2,82 ; 114,66 dan 1,96 ; 84,92. Jenis kontrasepsi yang digunakan yang dapat meningkatkan risiko adalah kontrasepsi hormonal jika dibandingkan dengan yang tidak memakai kontrasepsi, dengan rsio odd suaian 2,83 dan 95% interval kepercayaan 1,34 ; 6,00. KESIMPULAN: Pada penelitian ini terlihat bahwa faktor-faktor risiko dominan yang berhubungan dengan terjadinya kanker leher rahim jenis karsinoma sel skuamosa adalah umur yang lebih tua, tingkat pendidikan rendah dan penggunaan kontrasepsi hormonal.

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Risk Factors of Cervical Squamous Cell Carcinoma in Dr. Cipto Mangunkusumo National Central Hospital Jakarta 1997-1998BACKGROUND: Mortality of cervical cancer is highest among cancer in women. The histological type of cervical cancer is mostly squamous cell carcinoma. The purpose of this study is to show the risk factors of cervical squamous cell carcinoma. METHOD: The design is a case control study carried out in patients from Dr. Cipto Mangunkusumo National Central Hospital Jakarta during 1997-1998 confirmed histologically with cervical squamous cell carcinoma, who has not started any treatment. RESULT: From 302 women with squamous cell carcinoma of cervix examined, the high risk groups were found to be as follows : 1) 52-62 year age group (34,4%) with adjusted odds ratio (OR) 24,05 and 95% confidence interval (95% CI) 6,34 ; 91,24 2) low education level, elementary 1 no education compare with women with higher education level showed adjusted odds ratio (OR) 17,97 and 12,91, and 95% confidence interval (95% CI) 2,82 ; 114,66 and 1,96 ; 84,92 3) hormonal contraception compared with those who didn't use any contraception showed adjusted odds ratio (OR) 2,83 and 95% confidence interval (95% CI) 1,34 ; 6,00. CONCLUSION: This study showed that older age group, low education and hormonal contraception were dominant risk factors of cervical squamous cell-carcinoma.

Abstrak :
Penyintas kanker leher rahim masih mengalami ketakutan sepanjang hidupnya. Salah satu sumber ketakutan adalah kemungkinan mengalami kekambuhan walaupun sudah dinyatakan sembuh. Penelitian ini bertujuan mengeksplorasi kisah penyintas kanker leher rahim yang mengalami kekambuhan dengan menggunakan pendekatan kualitatif "life history". Pengambilan data dilakukan dengan wawancara mendalam pada dua penyintas kanker, analisa dengan menceritakan kembali kisah penyintas dalam bentuk tema. Hasil penelitian ini menemukan bahwa penyintas kanker leher rahim saat mengalami kekambuhan menerima kondisi kekambuhannya dengan berbagai proses kehidupan yang dialami yaitu terpenuhinya rasa aman setelah terapi dinyatakan selesai, kembalinya tanda gejala awal dan lanjutan, menjalani terapi kembali, penolakan terhadap kondisi kekambuhan, menghindari kontak sosial saat mengalami kekambuhan, memperoleh dukungan saat mengalami kekambuhan, sampai menerima kondisi kekambuhan. Oleh karena itu pentingnya pemahaman tenaga kesehatan khususnya perawat untuk mengetahui kisah hidup penyintas kanker leher rahim dengan kekambuhan sehingga dapat memberikan tindakan dan dukungan yang tepat pada setiap periode kekambuhan yang dilalui dalam meningkatkan kualitas hidupnya. ...... Cervical cancer survivors are still experiencing fear throughout her life. One source of fear is likely to experience a recurrence despite being declared cured. This study aims to explore the story of cervical cancer survivors who experienced recurrence by using a qualitative approach life history. Data were collected by indepth interviews in two cancer survivors, analysied by retelling the story of the survivors in the form of theme. The results of this study found that cervical cancer survivors experienced a recurrence while receiving recurrence with various process conditions of life experienced, that sense of fulfillment after the treatment was complete, marks the return of the symptoms of early and advanced, come back to therapy, the rejection of recurrence conditions, avoid social contact when experiencing a recurrence, obtaining support when experiencing a recurrence, to accept the conditions of recurrence. Hence the importance of understanding health professionals, especially nurses to know the life story of cervical cancer survivors with recurrence so as to provide appropriate action and support on any recurrence period which passed in improving the quality of life.

Abstrak :
Latar Belakang: Kanker serviks sebagai penyakit kanker tersering yang mendapatkan terapi pengganti ginjal berupa hemodialisis (HD). Gangguan ginjal yang terjadi pada kanker serviks dapat terkait kanker nya, nefropati obstruktif yang dapat menjadi sekuele kronik berupa penyakit ginjal kronik (PGK) maupun AKI (acute kidney injury) yang membutuhkan inisiasi HD.

Tujuan: Mengetahui kesintasan tiga bulan pasien kanker serviks yang membutuhkan inisiasi HD. Mengetahui hubungan antara usia, stadium kanker, faktor komorbid, hemodinamik pasca HD, akses vaskuler, rerata kenaikan berat badan antar HD, baseline kreatinin, baseline ureum dan baseline albumin dengan kesintasan tiga bulan pasien kanker serviks yang membutuhkan inisiasi HD.

Metode: Penelitian ini merupakan studi kohort retrospektif dari rekam medis pasien kanker serviks yang membutuhkan inisiasi hemodialisis. Penelitian dilaksanakan di RS Kanker Dharmais. Pengambilan data dilakukan pada 1 Juli 2023 sampai dengan 30 Agustus 2023. Kriteria inklusi yaitu Pasien berusia lebih dari 18 tahun dan Pasien kanker serviks yang membutuhkan inisiasi HD dengan indikasi akut di RS Kanker Dharmais. Kriteria eksklusi yaitu pasien dengan data yang tidak lengkap. Pengambilan data dari pencarian data dimulai dari login ke SIMRS RS kanker. Data akan dianalisis secara univariat, bivariat dan multivariat. Analisis univariat digunakan untuk mengetahui probabilitas menggunakan life table. Analisis bivariat menggunakan metode Kapplan Meier atau Regresi Cox Bivariat. Analisis multivariat dilakukan untuk mengukur pengaruh secara bersama faktor yang mempengaruhi kesintasan dan untuk melihat variabel yang paling dominan pengaruhnya.

Hasil: Didapatkan 252 pasien yang telah memenuhi kriteria dan dapat dianalisis. Hasil akhir multivariat menunjukkan variabel hemodinamik pasca HD sistolik < 110 mmHg dan rerata kenaikan berat badan antar HD ≥ 5%; HR 3,354 (95% CI: 2,346 - 4,795; p = < 0,001) dan 1,685 (95% CI: 1,125 – 2,521; p < 0,011) bermakna mempengaruhi kesintasan tiga bulan pasien kanker serviks yang membutuhkan inisiasi HD dengan kumlatif kesintasan adalah 49%.

Simpulan: Kumulatif kesintasan tiga bulan pasien kanker serviks yang membutuhkan inisiasi HD adalah 49%. Analisis bivariat maupun multivariat menunjukkan terdapat hubungan antara hemodinamik pasca HD sistolik < 110 mmHg dan rerata kenaikan berat badan antar HD ≥ 5%. ......Cervical cancer is the most common cancer that receives kidney replacement therapy in the form of hemodialysis (HD). Kidney disorders that occur in cervical cancer can be related to the cancer, obstructive nephropathy which can become a chronic sequela in the form of chronic kidney disease (CKD) or AKI (acute kidney injury) which requires HD initiation.

Objective: To determine the three-month survival of cervical cancer patients requiring HD initiation. To determine the relationship between age, cancer stage, comorbid factors, post-HD hemodynamics, vascular access, Weight gain, baseline creatinine, baseline urea and baseline albumin with three-month survival of cervical cancer patients who require HD initiation.

Methods: This research is a retrospective cohort study of medical records of cervical cancer patients who required initiation of hemodialysis. The research was carried out at Dharmais Cancer Hospital. Data collection was carried out from 1 July 2023 to 30 August 2023. Inclusion criteria were patients aged more than 18 years and cervical cancer patients who required initiation of HD with acute indications at Dharmais Cancer Hospital. Exclusion criteria are patients with incomplete data. Retrieval of data from data searches starts from logging into the SIMRS cancer hospital. Data will be analyzed univariate, bivariate and multivariate. Univariate analysis is used to determine the probability using a life table. Bivariate analysis uses the Kaplan Meier method or Bivariate Cox Regression. Multivariate analysis was carried out to measure the joint influence of factors that influence survival and to see which variables had the most dominant influence.

Results: There were 252 patients who met the criteria and could be analyzed. Multivariate final results showed post-HD systolic hemodynamic variables < 110 mmHg and Weight gain ≥ 5%; HR 3.354 (95% CI: 2.346 - 4.795; p = < 0.001) and 1.685 (95% CI: 1.125 - 2.521; p < 0.011) significantly influenced the survival of cervical cancer patients who required HD initiation.

Conclusion: The cumulative survival rate of cervical cancer patients requiring HD initiation is 49% at three months. Bivariate and multivariate analysis showed that there was a relationship between hemodynamics after systolic HD < 110 mmHg and Weight gain ≥ 5%.

Abstrak :
Tujuan. Penelitian ini bertujuan untuk mengetahui profil Treg (ditunjukkan oleh Foxp3), CD4, dan CD8 pada kanker serviks stadium lanjut lokal dan dampaknya terhadap progresivitas tumor dan respons radiasi. Metode. Setelah disetujui oleh komite penelitian, kami mengumpulkan data pasien kanker serviks stadium lanjut lokal yang menjalani radioterapi, di RSCM, Jakarta, pada Januari 2018 – Desember 2020. Subjek penelitian harus memiliki pencitraan pra dan paska radiasi dan spesimen blok parafin untuk memenuhi syarat dalam penelitian ini. Profil Foxp, CD4, dan CD8, akan dianalisis dengan imunohistokimia dengan penghitungan jumlah sel. Respons radiasi akan dianalisa dengan kriteria RECIST 1.1. Semua informasi klinis pasien yang diperlukan akan dikumpulkan dari rekam medis elektronik. Hasil. Kami menemukan bahwa sebagian besar pasien memiliki karsinoma sel skuamosa (93%), stadium IIIC (48%), dan menjalani radiasi saja (72%). Evaluasi RECIST menunjukkan 62% pasien memiliki respons lengkap, 28% respons parsial, dan 10% respons buruk (penyakit stabil dan progresif). Kami dapatkan median jumlah sel CD4 =29 (7 – 154), CD8 = 30 (6 – 227), dan Foxp3 = 36 (2 – 156). Tidak ada hubungan bermakna antara jumlah sel limfosit CD4, CD8, dan Foxp3 dengan volume tumor, dengan p = 0.858; p = 0.975, dan p = 0.723 masing masing. Tidak ada hubungan bermakna dengan dimensi terbesar tumor dengan p = 0.481, p = 0.480, dan p = 0.792 masing masing. Tidak ada pula hubungan bermakna antara jumlah sel limfosit CD4, CD8, dan Foxp3 dengan respons radiasi dengan p = 0.964, p = 0.296, dan p = 0.787 masing masing. Namun kami mendapatkan korelasi positif yang kuat dan bermakna pada jumlah sel tumor pada stroma, CD 4 - CD8 (r = 0.580, p=0.001); CD4 - Foxp3 (r = 0.699, p < 0.001), dan CD8 - Foxp3 (r = 0.652, p < 0.001). Kesimpulan. Sebagian besar pasien kanker stadium lanjut lokal yang menjalani radiasi memiliki respons lengkap. Tidak didapatkan hubungan bermakna antara jumlah sel limfosit CD4, CD8, dan Foxp3 dengan volume tumor, dimensi terbesar tumor, dan respons radiasi. Terdapat korelasi yang kuat dan signifikan antar sel imun (CD4-CD8, CD4-Foxp3, dan CD8-Foxp3) pada lingkungan stroma. ......Aims: This study aims to determine profile of Treg (shown by Foxp3), CD4, and CD8 in locally advanced cervical cancer and the impact to tumor progressivity and radiation response. Method. After been approved by the institution research committee, we collect data of locally advanced of cervical cancer patients who underwent radiotherapy, at RSCM, Jakarta, in January 2018 – December 2020. Studies subjects must have pre and post irradiation imaging and paraffin block specimen to be eligible in this study. Profile of Foxp, CD4, and CD8, will be analyzed by immunohistochemistry, by counting the number of cells, and radiation response will be analyzed by RECIST 1.1 criteria. All necessary patient’s clinical information will be collected from electronic medical record. Result. We found that most of the patients had squamous cell carcinoma (93%), stage IIIC (48%), and underwent radiation alone (72%). RECIST evaluation showed 62% of patients had a complete response, 28% a partial response, and 10% had a poor response (stable and progressive disease). We found median CD4 cell counts = 29 (7 – 154), CD8 = 30 (6 – 227), and Foxp3 = 36 (2 – 156). There was no significant relationship between the number of CD4, CD8, and Foxp3 lymphocytes with tumor volume, with p = 0.858; p = 0.975, and p = 0.723 respectively. There was no significant relationship with the dimensions of the largest tumor with p = 0.481, p = 0.480, and p = 0.792, respectively. There was no significant relationship between the number of CD4, CD8, and Foxp3 lymphocytes with radiation response with p = 0.964, p = 0.296, and p = 0.787, respectively. However, we found a strong and significant positive correlation in the number of tumor cells in the stroma, CD4 - CD8 (r = 0.580, p = 0.001); CD4 - Foxp3 (r = 0.699, p < 0.001), and CD8 - Foxp3 (r = 0.652, p < 0.001). Conclusion. Most locally advanced cancer patients who undergo radiation have a complete response. There are no significant relationships between the number of CD4, CD8, and Foxp3 lymphocytes with tumor volume, largest tumor dimensions, and radiation response. There is a strong and significant correlation between immune cells (CD4-CD8, CD4-Foxp3, and CD8-Foxp3) in the stromal environment.

Abstrak :
Background : Laminoplasty was developed to widen the spinal canal dimensions without permanently removing the dorsal elements of the cervical spine. The retained dorsal elements should aid in the prevention of muscle scarring to the dura and potentially reduce the incidence of postoperative instability. Cervical laminoplasty has been advocated as an alternative procedure to laminectomy for the decompression of the cervical spine. It provides favourable cord decompression and stabilisation of the cervical spine and is a simpler and safer alternative to anterior fusion and laminectomy for myelopathy and myeloradiculopathy, due to degenerative cervical stenosis. Most authors report outcome based on the Japanese Orthopedic Association (JOA) scoring system. Reported results include mean preoperative and postoperative scores for all patients, and a calculated rate of recovery is provided. The mean recovery rate after the Hirabayashi expansive laminoplasty is approximately 60%. To know the outcome, we evaluated 9 patients with degenerative cervical spinal stenosis that had been treated with laminopalsty using JOA score and Oswestry disability index questioner also the correlation between them. Methods : We performed pre and post interventional study on patients with degenerative cervical spinal stenosis with moderate until severe stenosis that had failed non operative treatment from January 2007 -June 2008 at Cipto mangunkusumo Hospital Jakarta. With JOA score as clinicall approach and Oswestri Disability Index (001) questioner by patient approach, we identify the cervical spine function of the patients before and after laminoplasty (1 month, & 6 month post operative) Results: There were significant difference of JOA and 001 score before and after decompression by laminoplasty with p<0.05. The improvement of cervical spine function also significantly increase until 6 months after surgery compare to the 1$ month post operative JOA and 001 score (p=0.028, p=0.035 respectically). There is strong correlation between them (r=0.804). Conclusion : Laminoplasty decompression technique can improve the cervical spine clinically (increase the JOA score) and quality of life (decrease the 001 score) of patient with degenerative cevical spinal stenosis.

Abstrak :
"ABSTRAK
" Latar Belakang : Gambaran foramen neuralis servikal pada potongan aksial memiliki keterbatasan dan tidak memperlihatkan foramen secara en face. Pemeriksaan MRI servikal dengan menggunakan potongan sagital oblik memberikan visualisasi dan diagnosis stenosis foraminal yang lebih optimal karena pengambilan potongan tegak lurus terhadap foramen neuralis. Saat ini prosedur operasional standar pemeriksaan MRI servikal di RSCM belum menggunakan potongan sagital oblik, sehingga masih belum dapat memberikan visualisasi langsung yang jelas dari foramen neuralis servikal dikarenakan anatomi dari foramen neuralis servikal tersebut.Metode : Pada penelitian ini, dievaluasi 23 subjek penelitian 5 orang laki-laki, 18 orang perempuan, dengan rerata usia 57 tahun yang menjalani pemeriksaan MRI servikal di RSCM. Sebanyak total 138 foramen dianalisis dari C4-5 sampai C6-7 untuk mengetahui perbedaan diagnosis derajat stenosis foraminal servikal pada potongan aksial dengan potongan sagital oblik MRI servikal. Uji hipotesis dilakukan dengan uji nonparametrik Mc Nemar dan hubungan diagnostik antara kedua potongan dinilai dengan analisis Cohen rsquo;s Kappa.Hasil : Terdapat perbedaan bermakna antara diagnosis kategori stenosis berdasarkan potongan sagital oblik dengan aksial MRI servikal dengan nilai p=0,001. Pada analisis Cohen rsquo;s Kappa didapatkan nilai r = 0,248 dengan nilai p=0,000.Kesimpulan : Terdapat perbedaan diagnosis stenosis yang siginifikan pada potongan sagital oblik dengan aksial MRI servikal dengan tidak adanya kesesuaian diagnostik antara kedua potongan tersebut. "

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" "ABSTRACT
"Background Axial images in cervical MRI examination has limitations in evaluating neural foramen and do not directly visualized it. Oblique sagittal images cervical MRI, that perpendicular to the neural foramen in axial images, provides optimal visualization and better diagnosis of foraminal stenosis grading. Currently, the standard operating procedures of the cervical MRI examination in RSCM are not yet using oblique sagittal images, so it still can not provide direct visualization of the cervical neural foramen due to the anatomy of the cervical foraminal.Method In this study, we evaluated 23 people 5 males and 18 females, mean age 57 years who visited RSCM and underwent cervical MRI. A total of 138 foramina were analysed from C4 5 to C6 7 both sides, based on axial images and oblique sagittal images to determine the diagnostic differences in cervical foraminal stenosis. Hypothesis testing was done with Mc Nemar nonparametric test and diagnostic association between the two images was assessed by Cohen rsquo s Kappa analysis.Result There is significant diagnostic differences p 0,001 of stenosis grading using axial images and oblique sagittal images cervical MRI. In the analysis of Cohen rsquo s Kappa, obtained r 0,248 with p 0,000Conclusions There is significant differences in the diagnosis of cervical foraminal stenosis between the oblique sagittal images and axial images and also there is no diagnsotic association between oblique sagittal and axial images.

Abstrak :

Latar Belakang: Ekstrak mangga telah terbukti memiliki efek antikanker terhadap kanker serviks, namun kemang (Mangifera kemanga) sebagai kerabat mangga yang belum banyak diteliti diduga memiliki efek yang sama. Tujuan: Mengetahui kandungan golongan senyawa yang terdapat pada ekstrak etanol, etil asetat, dan nheksan buah kemang serta menguji efek sitotoksiknya terhadap sel kanker serviks HeLa. Metode: Daging buah kemang diekstraksi menggunakan pelarut etanol, etil asetat, dan n-heksana. Uji fitokimia dan kromatografi lapis tipis menggunakan ketiga ekstrak digunakan untuk mengetahui kandungan fitokimia yang ada. Uji MTT dilakukan pada ketiga ekstrak yang diuji terhadap sel HeLa untuk mengetahui efek sitotoksik sampel dalam nilai IC50. Hasil: Uji fitokimia menunjukkan bahwa ekstrak buah kemang mengandung senyawa flavonoid, tanin, triterpenoid, dan alkaloid. Uji kromatografi lapis tipis dengan eluen non polar menunjukkan satu titik dengan Rf 0,82 pada ekstrak etanol; enam titik dengan Rf 0,16, 0,36, 0,49, 0,76, 0,82, dan 0,94 pada ekstrak etil asetat; dan enam titik dengan Rf 0,36, 0,48, 0,63, 0,75, 0,83, dan 0,93 pada ekstrak n- heksan. Uji MTT mendapatkan nilai IC50 terhadap sel HeLa, berturut-turut untuk ekstrak etanol, etil asetat, dan n-heksan, adalah 44,34, 16,41, dan 43,23 ppm. Kesimpulan: Ekstrak buah kemang memiliki potensi sebagai agen antikanker terhadap kanker serviks.

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Background: Mango extract has been proven in its anticancer effect against cervical cancer, however kemang (Mangifera kemanga), despite being a relative of mango, has not been thoroughly researched although expected to give the same effect. Objective: To identify the contents contained in the ethanol, ethyl acetate, and n-hexane extract of kemang flesh and examine its cytotoxic effect on HeLa cervical cancer cells. Methods: Kemang flesh was extracted using ethanol, ethyl acetate, and n-hexane. Phytochemical tests and thin-layer chromatography on the extracts were conducted to identify the phytochemical contents. MTT assay was carried out using the extracts against HeLa cells to find out the cytotoxic effect of the samples in IC50 values. Results: Phytochemical tests revealed that kemang flesh extract contains flavonoid, tannin, triterpenoid, and alkaloid. Thin-layer chromatography test with nonpolar eluent showed one spot with Rf of 0.82 in ethanol extract; six spots with Rf of 0.16, 0.36, 0.49, 0.76, 0.82, and 0.94 in ethyl acetate extract; and six spots with Rf of 0.36, 0.48, 0.63, 0.75, 0.83, and 0.93 in n-hexane extract. MTT assay obtained IC50 values for HeLa cells, respectively for ethanol, ethyl acetate, and n-hexane extracts, were 44.34, 16.41, and 43.23 ppm. Conclusion: Kemang fruit extract has potential as an anticancer agent against cervical cancer.